Tonsil enucleator



TONS IL ENUCLEATOR Filed May 18, 1927 2 Sheets-Sheet '1 April 2, 1929.B. D. LAJoRcE 1,707,736

TONS IL ENUCLEATOR Filed May 18, 1927 2 Sheets-Sheet 2 Cal Cal

Patented Apr. 2, 1929.

PATENT OFFICE.

BURDETTE D. LA FORCE, OF GTTUMWA, IOWA.

TONSIL ENUCLEATOR.

Application filed May 18,

My invention pertains to a tonsil enucleator and is a type of surgicalinstrument in the class of tonsilcctomcs or tonsil snares, the primarypurpose of which is to effect a removal oi the itaucial tonsils or othermore or less inaccessible tissues.

A general object of my invention is a surgical instrument suitable forthe above purposes and other operations in \\"l1lCl] lJUOillO- sta ndamputation in rapid succession are necessary for their successfulcompletion.

A further object of my invention is the construction of a tonsilenucleator or similar siu. 'ical instrument having a blade of thecharacter of a hcmostat lade with a metal loop operating therewith, theloop tunctioning somewhat as a snare and pressing the tonsils or othertissues to be removed against the hemostat blade, thereby crushing thetissues before the severing an d thereby perl'iernn ing a substantiallybloodless operation.

Another object of my invention is the construction of a tonsilenucleator or similar surgical instrument having the hemostat blade andthe wire loop or snare associated, whereby the snare can be slidlengthwise and manipulatcd independently of the blade to engage and gripthe tonsh or the like and by means of a trigger the snare may beoperated to press the tissues between the blade and such snare and thispressure may be increased by a. screw threaded device, pressing the tissues between the blade and the snare, and then when desired the bladeand the snare may be slid longitudinally, severing the tensils or othertissues.

lily invention will be more readily understood from the followingdescription and drawings, in which Figure 1. is a side elevation of mytonsil cnmrleator.

Figure 2 is a longitudinal section on the line 2-2 of Fig. in thedirection. of the arrows. v

Figure 3 is a plan view taken in the direction oi the arrow 3 of Fig. 1.

Figure is a front end view taken. in the direction oi the arrow l ofFig. 1.

Figure 5 is a rear elevation taken in the direction of the arrow 5 ofFig. 1.

Figure (3 is a plan view similar to Fig. 1 showing the parts of theimplement in a ditlerent position, as when crushing the tissues prior totheir severance.

1927. Serial No. 192,271.

Figure 7 is a plan view of the instrument showing the position aftersevering the tensils and moving the hemostat blade and the loop.

Figure 8 is a section on the line 88 of Fig. 7 in the direction of thearrows.

Figure 9 is an enlarged detail section on the line 9-9 of Fig. 6 in thedirection of the arrows.

Figure 10 is a plan view of the loop or snare.

Figure 11 is a transverse sectional detail on the line 1111 of Fig. 7,showing the posi tious of the catch.

The fixed structure of my device is formed substantially as follows:

It includes a main supporting arm 11, which forms a slidway, this armhaving an operating end 12 with a longitudinal slot 13 through such end.Such end has opposite projecting sides 14, the slot being suflicientlywide to pass through said projecting sides. The supporting arm has alongitudinal groove 15 positioned substantially centrally.

and has an abutment end 16 with an opening 17 therein. A handle 18extends downwardly from the end of the supporting arm adjacent theabutment end and is provided with a brace 19 which is adapted to fitover the top ofthe hand between the thumb and the lirst finger.

A sliding bar 20 is mounted on the arm 11 having a pair of pins 21 orthe like extending into the groove 15. This bar is flat and hasserrations 22 at its rear end extending outwardly beyond the body of thebar. The distal end of the bar forms a hemostat blade section 23, thisextending through the slot 13 "from the rear end 24 which stops the barby a ridge 25 transversely on such bar, and the forward end of thehemostat blade preterably has vertical corrugations 26 and a slightlyconvexed edge 27 as indicated most clearly in. Fig. 7, and a deepconcave groove 27 (Fig. 9).

On top of the slidable bar, having the hemostat blade, is positioned anoperating bar 28 which is held in position by means of a slide clamp 29,this having a base 30 which fits underneath. thesupporting arm 11 andhas a. longitudinal ridge 31 engaging one side of such supporting arm.The vertical side 32 ot the slide clamp extends upwardly along the sidesof the supporting arm 11 and the slidable bar 20 and is secured to theedge of the ope 'atinp; bar 28 by screws 32:3 or the like. A trigger illis rigidly secured to the base 2-50 of the slide clamp.

'lhe slide bar has a yolae 3:35 at its outer end, this yoke having aloop 37 is secured in such yoke, the-loop torn'iing a snare. This loophas two parallel sides 35% and a base end 35.), the end being;llattoned, as indicated in the cross section oil .llhg. 2, so that itmay be entered Qtltfjch'lstl in the slot 36 ot the yoke 135 and whenturned in the lwrizoutal position the loop is prevented from being d awnout of such slot. The distal end -Ztt) ol? the loop is prefer; lilycorrugated on the inside surface, indi 'ated at ll, forming part ol tsnare to cooperate with the hemostat blade.

Extending rearwardly from the operating bar is a screw el-Q, this screwextending through a catch l3 which is loosely mounted on the screw andis adapted to tit between the abutment end lb of the supporting arm andthe end istoi the slidable bar 20 having the heniostat blade. lower sm'lace sothlit arm he sawing by the handle 46 from a position'wlthfithelnindle inclined dmvnwardly and between the abutment 1G andthe end l l, or when swung upwardly into the position showlrin ll igsi 8and 11 the catch allows the upper surface oi the slid'able bar 2 toslide underneath, as is indicated by the relative position of such catchin Figs. 1 and 7.

The screw 42 slides tln'oauh the open' 17 in the abutment ltland has aknob ll" at its end to allow pressure ther on. ihnut lb is threaded ohthe sere w and has radial spokes ll) to allow ready pressure thereon inscrew m the nut tight against the abutment 16 The mechanicalmanipulation of mylenu cleator is substantially as 'l'ollouns:

The slide bar 20 may be moved longitudp nally oi thesupporting arm 11 bygrippingthe ser 'atioi'is ZZ when thehaiulle is in a vertical.pesitionan d when this bar thrust out\ 'ard into the'piisition shown inFig. 2 so that the ridge eng a the r tar part fZ l oi the operatuni;ondoit thodevice, such bar 15 in v I u 1 its extreme position. In oroerto hold the hen'iostat blade in this position the handle l6 of the catchis dropped to one side or the other so that, the catch tits between tl eabutment end it; of the support'ii'iti; arm and the end. ll o l theslidable bar ill). 'lhis, therel'ore, reslraius the rearvmrd moven'ientot the hemostat blade. manipulated by first screwing the clai'npingscrew 4.8 tinvards the knob ll oi the operating bar and by means of thetrigger 3-]: thrusting the loop outwardly through. the sides of the slot1&5, the sides 355 of such loop pass' g' on the outside oil the hemostatblade, as 1llustrated in Fin". 7.

To draw back this blade he first finger of the hand may pull on thetrigger 3a which a slot 36 therethrough, and

loop engages the end ot the heinostat bia This catch is llat on the Theloop or snare may be gradually pulls the snare inwardly, the operatingbar hlltlillg on the slidable bar :20 which, as above mentioned, is toldstationary, being so held by the catch 4:3. The iii-n gger may be d awninwardly until the distal end of the le. Then to give increasedpressure, the not i}; is jammed tight against the abutment end 16 ot thesupporting arm ll, the operator utilizing thespoluasii) in turning this.Then, when desired, the :atch may be released troni thebael: ol' thesliidal'ile bar 20 by shitting same to the upper position and thehemostat blade with the loop ill-.te snare may then. be drawnrezu'wardly jt'rcely by the tri 1;; Bl, these moving together or, if dsired, by further jamming thenut -l8 against the abutment.

In manipulatingtheenuclcator in a surgical operation, for instancetoreniore the tonsils, the laucial tonsil is engaged by the metal loopby'pressing the distal end elf such loop when in its outer positionagainst the posterior pillar of the throat and the iaucial tonsil;lBressure is made in a direction to "force the loop in back'ojt thetonsil and by manipulation of the instrun'ient thetonsil is made tobulge the anterior pillar of the throat "forward. W hen the anteriorpillar is seen to bulge forward, it is pressed upon by thelirst lingerof the unoccupied hand or the operator to cause the tonsil to slipthrough the'loop oi the snare. l Vhen it is dete mined that this hasbeen ZLCCOll'lPllSllBtl, the trigger is pulled, which brings the looptightly against the tissue oi the tonsil and compresses this tissuebetween the hemostat blade and the distal end of the loop. Considerablepres sure may be brought to bear by pulling on the trigger but, as thisusually is not soilicient to thoroughly crush the tissue, the nut it; isoperated as above explained and when the tissue has been thoroughlycrushed the tonsil may be grasped by forceps. The catch which holds theope 'ating bar and the hemostat blade in place is released and eitherthe trigger ispulled by the linger or the nut is is tin'ned, whichprocedure severs the tonsil from the tissues that have, been held in thehemostat. 'lhese seve 'al operations may be performed with my instrumentto ell'ect the complete enucleation oi? the tonsil without hemorrhage.

llt will be noted that the grooves through the operating end 12 and theprojecting ends l/l oi the supporting, arm give a pport to the loop orshare and considerably stilien the wire so that this wire has arelatively long longitudinal support.

in my invention a hen'iostat may be conside ed as formed by a itenestrain which one part, that is a relatively stationary part, is tormedby'thehemostat blade 23 and the other by the loop or snare, this forming, afenest a or window when open. Thus the tonsil may lit) be introduced inthis fenestra when the win- (low structure is open and the tissuessqueezed by closing such window structure, and finally amputated by acomplete pressure between the heinostat blade and the end of the loop,and by the retraction of the hemostat blade in such a manner that thewire forming the loop will break through the weakened tissues when it isfurther retracted through the slotted part of the frame.

1t may be more readily understood how the hemostasis takes place in suchan operation by those not es1 ccially familiar with such operations byknowing that when a blood. vessel is thoroughly crushed and its lumen isclosed and. more or less glued together by pressure that the blood inthe lumen of the vessel at the place where the crushing is produced andadjacent thereto becomes coagulated and blocks the flow of blood in thevessel. thus preventing bleeding.

In reviewing some of the important features of my invention it will beobserved that a mechanism is provided whereby the tissues to be severedare crushed directly in the place where they are linally completelysevered which it is believed is accomplished in a unique manner.

Another very important feature of my im proved instrument is the verysimple manipulation necessary to accomplish the op eratien abovedescribed.

l vl'ien it is understood that many very badly diseased tonsils are verydeeply imbedded in the tissues, and which fact makes their removal moredifficult, it will be readily appreciated by operators to have aninstrument whereby such tonsils may be removed in a simple and bloodlessmanner.

Cl. he simple manner of the removal of the tonsil with my improvedinstrument is especially due to the provision of a mechanism whereby theengagement of the tonsil is el liected by lassoing it with a wire or thelike loop which is held and supported in an open manner. By being heldand thus supported the wire or the like loop will stand the pressurenecessary to press it down around the tonsil. Having the tonsil onceengaged in the provided lasso the other unique features are provided ina very simple manner of manipulation to thoroughly crush the tissuesabout the tonsil and to sever them where they have been crushed and inthisway perforn'iing a blood less operation.

A special feature of my. invention is that the heavy wire loop issupported at the sides where it passes through the guide slots in such amanner that this cannot collapse. This distinguishes from the type offlexible snare in which a wire is contracted, squeezing the tonsil andeventually cutting the same. With my construction I have the benefit olthe snare-like loop in that my wire loop may be readily titted behindthe tonsil.

Another characteristic feature oil my invention is that the snare-likerigid loop is contracted around the tonsil, crushing the tissue ot' thetonsil between the wire ot" the loop and the dull ed go of the hemostatblade. Therefore, by this construction and the manner of retracting theloop, the tissue may be thorou hly crushed a ainst this stat blade, andafter suflieientcrushing, the tissues are cut in the exact place inwhich they have been crushed. This, to a great extent, prevents ahemorrhage.

Another characteristic feature of my invention is that the heinostatblade and the loop, when the tissues are crushed therebetween, may beretracted .into the guide structure at the end of the instrument, thusentirely clearing the loop from the severed tonsil.

My invention also distinguishes from the tonsilloton'ies in which thetonsil is severed by a moving, knife-like construction having a sharpblade, and in some of these, the tonsil is held in a rigid position by aholding device that the blade may press the tonsil against this holdingstructure, but in this case there is no el'l'cctive crushing oil? thetonsil. at the very place at which it is subsequently severed.

\Vhile the description of the instrument herein shown, described andclaimed, in a preferred form, is especially designed to enucleate thefaucial tonsil in a bloodless man ner, it will be easily understood thatinstruments embodying the unique features herein described may beprovided in instruments made smaller or larger to be adapted to such)arts as the nasal cavities, the rectum, or al domina l. cavity, and thelike, for the removal or tissues and abnormal growths in a bloodlossmanner.

Various changes may be madein the principles of my invention withoutdeparting from the spirit thereof, as set forth in the description,drawings and claims.

I claim:

1. A surgical instrument having a dull liemostat blade and anon-collapsible snare like wire loop, means to move said blade and looprelatively to each other to crush tissue between the end of the bladeand the wire loop, and to sever such tissue.

2. A surgical instrument having a dull homostat blade and anon-collapsible snare like wire loop, slidably mounted one relative tothe other to engage and crush tissue between the end of the blade andthe wire loop, and means to slide the hemostat blade and the looptogether with tissue compres l therobetween.

3. A surgical instrument having a sup porting structure with a dullhemostat blade slidably mounted thereon, a wire loop likenon-collapsible snare also slidably mounted on the supporting structureto slide relative to the hemostat blade to crush tissue between iii theend of the hlad and the end, oi the snare, and means to hold. thehemostat blade ritationary during the sliding ot the si'iare.

i. A surgical instrument having a Supporting structure with a slidingher having a (lull lIQD'IOSl HlJ blade and a slidable operating herhaving a non-collapsible snare like wire loop, mains to latch theslitlable bar with the hcmostat blade in one position, and meane toslide the one o with the .llQiiiOStttl) blade latched to compress tissuebetween the end oi the blade and, the snare.

5. fr surgical instrument, as claimed in claim et, meann to unlatch the:lidable bar and to allow sliding of said ha ancl hemostat blade and thesnare, with tissue prcsneil between the bind: and the snare.

(3. A. surgical instrument having a eupporting structure with an ope'atin g end having a slot, at slidahlc bar having;- a dull hemoetatblade fitting in said slot, a noncollapeihle wire loop like snareslidablc through the said slot, and ncans to slide the snare to compresstiesue bot-ween same and the end ol the hemosl'at blade.

7. A surgical instrument having a oupporting structure with an operatingend having a slot, a slidable her having a (lull hemostaiblailc h ttingin said slot, at non-collapsible wire loop like snare elidzible throughthe said slot, means to'siide the snare to compresis tissue between someand the end of the hemontat blade, and means to latch the Sikh able barwith the heinoistat blade in the slot, said means being l'UlQtLSEllJlQto allow movement ot' the bar and the blade with the anarc, havingtissue crushed. between the blade and the snare.

8. A surgical Illihtl'llllltl'll) having, a supporting Structure, anoperating end having a hint, a sliilable bar having a hemoslat bladelilting in said slot, a non-colla1 )eible snare lihe wire loopextending; through the slot in Htlltl operating); end, 111103.115;actuated by a lie- ;ger to slide the snare relative to the said blade tocrush tieisue between the blade and. the nnare, and manually operztcdmeans independent oil? the linger opera ted device to incr aisle thepressure of the snare against the blade.

9. A. surgical instrument, as claime: claim 8, a latch mounted in thesupporting structure positioned to engage the slidablc bar and to holdsame with the blade in the slot, said latch being relezinahle to allowelitiingg' oi the said bar under said latch.

10. A Surgical instrument having a supporting; arm with an abutment atone end and an operating end having a slot, a slidublc bar having ahen'iostat blade mounted. on the hupporting arm, the blade fitting); inthe said slot, with means; to limit the forward, movement Ojii said,blade in the slot, or operai ing l ar rilidahly mounted on thesupporting bar, a wire loop like non-collapsible snare connected to theoperating bar and extending through th i said silot, means to latch theslidable blade with the slidahle her with the hemostat blade in. theslot, and a trigger device connected to the operatic bar to slide samerelative to the :aliclahle bar to compress tissue between the hen'iostatblade and the end of the snare.

ll. 1, surgical instrument, as claimed in claim it), and a Screwthreaded niecln'inisim operatively com meted. to the operating bar andcausing an increz eed tension on the loop lihe snare, the said latchbeing releasable from the elitlable bar to allm :-1iinultaneous movementoft the l'ieli'iostat blade and the snare.

12. A surgical instrument comprising; in combination a f-iupporting armhaving an operating end. with a slot thercthrougli, a slidable barmounted thereon, having a hcinoetat blade titling in the said slot, anllpel'tlllll'lg' bur Slidable on the slidable bar and lowing); a yohe atits; outer end with a slot therethrough, a loop 'l'ormingg' a snare,having;- one part littii'ig in said yoke and ineertahle through the saidslot in the yoke, the loop extending through the slot in. the operatingcurl oi? the supporting arm, and mean: to slitle the r-slidahle bar oCOHlPYEF-lS tissue between. the loop and the hcmostat liilade.

13. in a surgical instrinnent a ni| )porting arm having an ope 'atingend with a slot thcret irougih, a oiiilable bar having a homostat bl roetilting in the said slot, an operating bar 141 dine; on the slidable haand. having a yoke at its outer and, with a slot ii said yoke, a loopforming a entire having a flattcued end, the said flattened. end beinginner-table through the slot in the yoke, two sides of the loopextending through the slot in. the operatio end, and. the distal end ofthe loop having internal corrugations.

let. in a surgical ins-:irument a heinorstat blade, lnivine means tosupport 541M110, a snare l'ke loop elidahle in. relation to the saidblade,

I the blade having an wine with a concave groove, meai'n; to draw thedistal end of the loop into the said groove.

15. A, surgical. instrument comprising in combination a supporting armhaving a pistol gri p, on operating end on said arm having a slottheretlnrougrh, an almtment extending upvardly at the other end, aslidable bar mountecl on the supporting arm, interacting means to guidethe elidahle her, said bar having a hen'iostat blade fitting in the saidslot, an operating bar s-sliclahle oi. the elirlable bar and having aloop like snare connected thereto, the snare extending through the saidslot, a screw extend pig rearwardiy from the operating bar throi i theabutment, a catch having sides; partly encircling the mid screw andloosely fitting thereon, the said catch in one position fitting; betweenthe eml of the sli=1lable bar and. the abutment and in another

